by Deborah Cornwall, Cancer Advocate
Part 1: Cancer’s Global Reach and Efforts to Fight Back
Cancer isn’t just a North American problem, but a global one. According to the American Cancer Society (ACS), worldwide cancer incidence is rising from 14.1 million new diagnoses in 2012 to a projected 21.7 million in 2030 as a result of population aging. In addition, incidence and death rates could rise even faster in low- and middle-income countries that are adopting Western lifestyle habits (with their associated smoking, high-fat diets, reduced exercise, and infection problems); impacts are severe since many of those countries lack the medical resources and healthcare infrastructure to properly diagnose and treat the flood of diagnosed patients. The complexities of addressing such a cancer epidemic require multiple strategies, and many of them require research, collaboration, and information. They’re interconnected.
- Epidemiological research: To define the scope and nature of the problem and where it is. Geographic areas differ in their cancer incidence patterns and the prevalence of particular variants of the disease.
- Public education: To determine from that research what the public needs to know to prevent cancer or to detect it early enough to permit effective treatment.
- Scientific and clinical research: To make progress in cancer control and treatment.
- Infrastructure resources: To facilitate sharing of tissue samples, scientific progress and discoveries.
Subsequent short articles will address each of these for readers who want to learn more. This article addresses how the problem is being defined (Epidemiological Research).
What and Where is the Problem?
Tobacco is the largest proven cancer cause worldwide. ACS’ Cancer Facts & Figures Report 2016 reports that tobacco causes almost 6 million deaths each year, 80% of which occur in low- and middle-income countries. Tobacco use killed 100 million people in the 20th century and is projected to kill 1 billion in the current century. While tobacco deaths decline in high-income countries, they are skyrocketing in low-income ones as approximately 18% of the world’s population continue to smoke and expose nonsmokers to deadly chemicals from secondhand smoke. The Word Health Organization’s (WHO) World Cancer Report, analyzing these trends, is available for free download through the WHO’s International Agency for Cancer Research (IARC).
The tobacco threat is well known and remains a huge problem. The first global public health treaty was crafted under World Health Organization (WHO) leadership in 2005, focused on controlling the supply of and demand for tobacco products. The countries that signed the treaty are expected to institute tobacco control policies and to cooperate with each other in reducing tobacco use. Sixteen countries (including Argentina, Indonesia, Malawi, and the United States), many of which are major tobacco growers, have not yet signed on. Despite tobacco control progress in North America, only about 18% of the world population is covered by smoke-free laws, and only 10% live in countries with comprehensive tobacco tax policies.
Information about the problem is a critical underpinning for every country’s public health and cancer control policies. A significant resource toward that end is the Cancer Atlas, which was created by a partnership among ACS, the WHO’s IARC, and the Union for International Cancer Control (UICC). It was intended to provide a tool for sharing data and best practices as a foundation for governmental decision-making to improve cancer control policies and outcomes.
The UICC is a convening, capacity building, and advocacy organization that promotes greater equity in access to care and advances cancer control to higher visibility among the world’s health priorities. It includes more than 150 countries and over 950 organizations that include cancer societies, ministries of health, patient groups, researchers, policy makers, and over 50 strategic partners. Sharing of best practices is a major goal, together with tracking specific indicators that reveal whether national policies for cancer control are generating sustainable and effective programs and generating the needed outcomes to reduce incidence and death rates.
The ACS and the WHO / IARC work to influence local cancer prevention and detection worldwide.
ACS’ global priorities focus on making cancer control a political and public health priority, developing local cancer control capacity (especially in low- and middle-income countries), providing access to palliative care (effective pain and nausea control), and educating the public through multi-lingual online cancer information. Intensive ACS efforts are now dedicated to both tobacco control and women’s cancers.
Collaboration between ACS and the WHO has generated a comprehensive framework to reduce death from non-communicable diseases. Key strategies include increased screening for breast and cervical cancers (the most commonly diagnosed cancers), decreasing smoking prevalence, increased access to palliative care, and HPV vaccinations to lower cervical cancer rates. ACS also works with civil society worldwide to share best practices for cancer control organizations in governance, financial management, fundraising, program design and management, and monitoring and evaluation of results.
The IARC is all about cancer control and public health policy research. IARC does not conduct clinical research but rather focuses on cancer trends and the impacts of cancer control policies. It generates an evidence base that supports country cancer registries in gathering and analyzing data about the cancer burden in different locales and in translating identified environmental / lifestyle risk factors into potential prevention strategies.
In addition, the IARC generates the WHO “Blue Book” which classifies human tumors and maintains a global cancer biobank that currently holds 6 million tissue samples from over 600,000 individuals. Finally, IARC the training and training of cancer researchers, especially in cancer epidemiology and cancer registration, provides an important resource to low- and middle-income countries. IARC funding derives from the European Union, National Cancer Institute (US), Institut National du Cancer (France), and a variety of international and national charities, including the Bill and Melinda Gates Foundation.
Knowing the location and scope of the cancer problem is the bedrock for global cancer control.
Read Part Two: What Can Science Do to Stop Cancer?
Read Part Three: What Resources do Researchers Need?
Read Part Four: What Does the Public Need to Know?
A legislative advocate and speaker with the American Cancer Society’s Cancer Action Network, Deborah J. Cornwall is the author of Things I Wish I’d Known: Cancer Caregivers Speak Out and Things I Wish I’d Known: Cancer and Kids.